In early January we were contacted by Roy Smith. His father, Arthur L. Smith, had the Wolf Procedure in 2023 and was part of the Wolf Pack.
Roy informed us that unfortunately his father had passed away from complications related to other illness. Arthur always spoke very highly of Dr. Wolf and he was very thankful living without atrial fibrillation.
Arthur wrote a long article on his experience with the procedure (then called the Wolf Mini Maze) and he wanted to share it with the world, which he did publishing it on medium.com, he titled his article "A Side-Splitting Surgery Recollection"
With the permission of the family and medium.com we publish his story here.
Thank you very much Arthur.
Arthur L. Smith (1952 - 2025)
A Side-Splitting Surgery Recollection
by Arthur L. Smith (Jan. 18, 2024)
I am 71 and it is no great accomplishment that I have had more than my fair share of serious afflictions, chronic diseases, and surgeries thus far on this unpredictable, but nonetheless, extremely humorous, road of life.
My recent experiences will be the grounds of my narrative of my recent procedure with the “the Wolf Mini-Maze,” a unique approach to Atrial Fibrillation (“AFib”) cure.
But first, some history; as a battered soldier aptly said, “Scars are our souvenirs of life.”
Going back in time I can remember a few adolescent encounters that led to stitches, a puncture when I slipped climbing a hurricane fence and impaled my arm, a nasty gash from glass on the beach and a couple of cysts that were eradicated. Then there was a long period of hospitalization solitude until a very tough trio of tsunami-like events hit me in 2008: Prostate Cancer, Divorce (#2) and sale of the Company I had built and managed for 22 years.
Prostate Cancer is a big deal yet, thankfully it was discovered early. My abnormally high PSA 8 score was a godsend and alerted my internist early when I was 56. Prostate cancer runs rampant in the Smith family taking my father, uncle, and several Smith cousins prematurely. Being a Houstonian, I went straight to M.D. Anderson and sought the services of Dr. SM, a genius with the new DaVinci robotic surgery. The troublesome organ was removed satisfactorily, protecting the all too important delicate nerve endings. My prostate was pronounced non-malignant and had not metastasized. The intervening five years were quiet seas bereft of prostate agitation.
Silent waters were dashed in 2013 when my PSA shot up again and I was forced to return to MD Anderson. My oncologist, Dr. KH, pointed me to the Radiation Therapy Men’s playground where I enjoyed ultimate hydrating, telling tired jokes with old men with puffy bladders. I remember striking up quite a rapport with the technicians who put me through contortions to precisely focus the bursts of radiation. My oncology team laughed at the best of my story and joke collection over the next 25 weeks of radiation therapy. At the end of the ordeal, I was given a gold star and encouraged to “ring the bell” again.
Then came Atrial Fibrillation, the damn affliction that has haunted my life since 2010.
I vividly recall my first encounter with A Fib. I was completely baffled when my heart started pounding out of control over a holiday weekend. The debilitating affliction occurred during a weekend in Galveston; Holly, my wife, checked me in to the University of Texas Medical Branch (UTMD) Emergency Room. Some timely injections quelled the cardio earthquake. Here, I was diagnosed with a “Holiday Heart,” a.k.a. Atrial Fibrillation. With the erratic organ temporarily at bay, I declined UTMD’s recommendation for further testing. My next step would be to seek a cardiologist in Houston, at Memorial Hermann, Memorial City.
While my heart continued to have periodic AFib “episodes,” the durations were generally short and tolerable. Yet, my Cardiologist warned me of increasing intensity and increasing concentration. The next wall of defense, so to speak, would be to control my growing tendency to Afib episodes. I saw several cardiologists and they all, sternly recommend: An Ablation procedure.
An Ablation is widely implemented by Electro Physiologists and Cardiologists for patients with A Fib. The procedure is performed with a catheter which originates in the femoral artery of the crotch. Here is a paste in description:
Ventricular tachycardia ablation
Ventricular tachycardia (VT) ablation uses cold or heat energy to create tiny scars in the heart to block faulty signals that (are believed to be the) cause of a rapid, erratic heartbeat.
Ventricular tachycardia occurs when the heart’s electrical signals cause the lower heart chambers (ventricles) to beat too quickly. The goal of VT ablation is to restore a regular heart rhythm.
Ablations are generally voluntary efforts by the patient to quiet AFib symptoms.
I had four!
But, before Ablation Number One came the cardioversion carnival!
My unpredictable AFib arrhythmias were first combatted with a Duke’s mixture of medications such as Metoprolol and Amiodarone, among many others. My doctors, like mixologists at the Ritz Hospital bar, experimented with many cocktails of drugs which, while they did bring unfortunate side effects, delivered “No Lasting Relief from A Fib”. The answer: Why not try out a cardioversion with quick, highly- predictable positive results?
It is hard for me to recollect how many times my doctors and I became so distraught with my unruly palpitating ticker that a cardioversion procedure was required. The procedure — quick, low-energy shocks to the heart to restore regular heart rhythm — is performed in the hospital and requires at the least, an outpatient’s afternoon commitment. I have erased any distinct memories from my multiple cardioversions. You prep, you lay on a gurney, you are IVed, then you are wheeled into the chamber of defibrillation horrors. A quick shot of anesthesia, the doctor smiles and, before your eyes close, he zaps you with the defib paddle. Miracle!
You recover in very short order with a normally functioning heartbeat. Whew! Just wish cardioversions could mature medically into long-lasting treatments!
After several years on the cardioversion carnival carousel, I remember my first ablation (circa 2000) as particularly unsuccessful. After I had the procedure at Willowbrook Hospital I did not feel well, but I was encouraged to recover quickly and not spend the night in the hospital. Released to home care and feeling OK, I attempted to shower and collapsed on the bathroom floor, felled by a Transient Ischemic Attack or TIA. The ER folks’ ambulance was summoned, and I spent a couple of incremental days in the hospital. While I bounced back rapidly, my “mini” or “warning stroke” was unsettling; I was mentally shocked indeed and there was some lingering confusion and temporary memory loss. The ineffective ablation and TIA were enough. My wife was insistent that I move on from the care of my young Asian cardiologist. I recall that Dr. SS was best described as confident to cocky, with zero bedside manners.
For my second ablation I ultimately discovered (?) the finest Electro Physiologist (EP) in the Methodist Health System: a young Asian physician, Dr. TR. (There were other digressions with charlatans posing as young cardiologists at Memorial Hermann but let that rest.)
To his credit, Dr. TR — considered one of the best EPs that Houston Methodist has to offer, gave me a dozen years and three ablations to (ostensibly) tame my A Fib malady.
Third and Fourth Ablations: Not much variation to discuss other than two separate implantations of LINQ heart monitor chips in my chest by Dr. Cardiologist Number One, and a replacement new battery by Dr. TR twelve years later. (When I visit the veterinarian, I admit that I can relate to my canine pet, felt similarly “micro-chipped. I can assure you that LINQ installation (requiring an outpatient half-day commitment) is somewhat more than a morning afterthought.)
Oh, along the way I need to confess that my wild heartbeat did not automatically revert to “Sinus” (normal 70 HBP) but “Flutter” *abnormal but (south of A Fib 150+ HBP) around 100- 120 HBP. “Flutter” is a state of heart disruption that the cardiology world tolerates and because you are “not in A Fib” — seemingly has little interest in you, the average patient, me!
Ablation Number Four was quite different as it wasn’t an Ablation. Dr. TR and Dr. SD, my friendly outgoing cardiologist and vintner, had become (as I had) somewhat tired of yet another A Fib ablation procedure for me. We had “run out of A Fib runway.” It was time to accept the inevitable, a Heart Pacemaker installation. My friends at Boston Scientific and Medtronic were waiting in the wings.
The Medtronic pacemaker procedure with Dr. TR was uneventful and, thankfully, during the time I was comatose, he ripped out the LINQ chip (now an unnecessary heart rate monitor) from under my left breast.
I had little issue with getting used to my pacemaker which now rests in a protruded area below my left collarbone. No problems. No issues. My new physician, cardiothoracic superstar Dr. Wolf, is not sure that I ever needed it. That said, the pacemaker causes me no inconvenience at the airport or any worries. And, the silver lining is that it should kick in if my heart rate falls below 50 BPM.
The Mini Maze Procedure and Exciting Aftermath
I am welcomed by Mark, a cheery, upbeat fellow who quickly stamped my paperwork then asked my wife and me to take a seat in the reception area: tranquil, quiet and hardly populated (well it was 5:30 am!)
I could barely locate a rest room before I was being ushered back to the Pre-Op preparation area. Here the nurse assigned to my case helped collect my personal items before instructing me to “Strip it, all!”
I settled into a comfortable gown, no underpants, no watch, no nothin’ except my wedding ring (an oversight, it is confiscated soon thereafter.)
Then, after a half hour of morning boredom (the TV was inoperative) , the hospital world descended on me like flies on rotting carrion.
I was quickly wheeled out of my semi-private patient portal and sent off to “where knows who.” It was time for serious preparation for my upcoming procedure and everyone was high energy and highly focused. To be fair, it seemed like midnight to me, but it was probably 6:30 am.
Time for a good vein to be uncovered for an “IV duct” or portal. Yes, there were options on either arm but my left fist seemed the ideal option. Good. That was a non-trivial experience, but the best was yet to come.
In prior days I had experienced urinary tract issues including a kidney stone which had to be removed after I was diagnosed with bladder blockage. So, no surprise that the Foley Catheter became the Unholy Catheter.
(Gentlemen cover your eyes, read no further, this is not a review which you, hopefully, will ever experience!”)
The Bastard Catheter: Catheters may not win a lot of best-loved medical device awards, but they are hospital staple. We may shirk the thought, but, during surgery the balloon Foley is essential as it provides a highly appreciated exit for the bladder. Furthermore, I confess I am afflicted with overly demanding bladder anger during the night and I sleep best with Foley. Though don’t tell my wife!
OK, enough catheter talk. Let’s get on with it.
Now, as relaxed as one can be in such circumstances, fully IVed and naked as a jaybird, I was ready for the rubber tube. Only one problem: More than one nurse was unable to snake it to the promised area of my bladder. It didn’t matter who tried; my hospital friends, female and male, were thwarted.
With each unsuccessful attempt at catheterization, an ever-larger group of hospital personnel gathered to observe my lower torso and my, now, unexpectedly in the spotlight, on the front page, shy and shriveling tallywhacker.
As much as I loved all the attention I was garnering, the discomfort was beyond a memorable childhood thrashing and was approaching “Wholly Beyond Belief!” This is when I consulted the special Hospital Pain Index chart of Emoticons and determined that I was bridging the gulf between “Mildly Uncomfortable” and “Get Me the Hell Out of Here.”
It was time to summon the Urology Department, Drs. H and C. In short order (most appreciated by me) the gentlemen Doctors arrived, consulted the charts, reviewed the unsuccessful accounting of previous attempts and . . . with no delay or hesitation . . . stuck that Foley catheter in my bladder in seconds, like a professional flite dart in a barroom dartboard. Dr. H, I thank you with all my heart!
Now, IVed and cathetered, I was harnessed to a multitude of machines measuring blood pressure, heartbeat and the like. The drama had subsided, and I was ready to kick back — and WAIT! Earlier experiences at the Catheter Lab at Methodist Hospital included extended periods of downtime. Not so today. Thankfully, Dr. Wolf did not disappoint me; the 70-year-old bearded physician poked his head into my cubicle a few minutes later. “You ready to get this done?”
A few words about the enigmatic and charismatic Dr. Randall K Wolf, fellow of the DeBakey Heart and Vascular Center in Houston. Dr Wolf is a cardiothoracic surgeon and the inspiration behind the Mini Maze Procedure to treat AFib. In addition to his work as a radio personality, Wolf has been a visiting professor in 18 countries and has performed 3,000 Mini Maze procedures since 1980. But Wolf is one of a kind: Not every nationally-recognized heart doctor is an amateur magician and member of the Academy of Magical Arts.
A rumor in his office was that Dr. Wolf had staged an acclaimed magic show for the medical staff for Halloween. Indeed, I learned that Wolf’s amateur magician status has attracted a celebrity following including the showmen magicians, Penn and Teller. It seems that Penn Jillette is a drinking buddy of Dr. Wolf and once, with the permission of a Mini Maze patient, Jillette observed Dr. Wolf working his surgical magic at the Medical Center. (For the record, Jillette, the tall one who talks, collaborated with Dr. Wolf on a novel magic trick whereby Dr. Wolf’s surgical probe is employed to discern a wedding ring from the interior of a watermelon. No kidding — Watch here: Watermelon Surgery with Penn and Teller
Anyhow, I underwent the Mini Maze minimally invasive surgery procedure on November 5, 2023. I did require a few days of hospitalization and later, a partial lung collapse extended my Methodist hospital vacation.
But, you want to know if it was all worth it? Minimally invasive surgery is no walk in the rose garden and, I will confess, there was some real pain and irritation that lasted a month or so.
Now, in the rear-view mirror, my Mini Maze adventure seems well worth it!
Everything has gone great in subsequent weeks, and I am very pleased to share that my health has undergone significant improvement. Most encouraging is that I have been free of AFib “flutter” with a steady 70 beats per minute “Sinus” rate. Stay tuned!
Those seeking further information on AFib and Dr. Randall Wolf are directed to the following:
https://wolfprocedure.com/what-is-atrial-fibrillation